Misery Beyond the War Zone: Life for Syrian Refugees and Displaced Populations in Lebanon ( Doctors...

7/29/2019 Misery Beyond the War Zone: Life for Syrian Refugees and Displaced Populations in Lebanon ( Doctors Without Borders/Mdecins Sans Frontires - MSF)

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MSFs second survey of Syrian refugees in the past eight

months shows severe deterioration of living conditions and

health status.

M

ichaelGoldfarb/MSF

Misery beyond the war zone:Life for Syrian refugees and

displaced populations in Lebanon


2/12

Turkey

Syria

Jordan

to Iraq

Lebanon

Beirut

Tripoli

Saida Damascus

Homs

Daraa

Hama

Aleppo

Idlib

Bek

aa

Vall

ey

83,314

238,1

49

2

56

,450

170,6

4

3

The figures on this map represent the total number

of Syrian refugees registered or awaiting registration

in the neighbouring countries: Lebanon, Iraq, Jordan

and Turkey. Figures were sourced from the UNHCR in

February 2013.

See http://data.unhcr.org/syrianrefugees/regional.php

for updated figures

2 Misery beyond the war zone

Since November 2011 Medecins Sans

Frontieres (MSF)/Doctors Without

Borders has been continuously ex-

panding its humanitarian and medical

response to provide urgent assistance

to the Syrian refugees in Lebanon.

The organisation is presently offer-

ing medical services in Tripoli and in

various locations of the Bekaa Valley,

namely Baalbek, Aarsal, Hermel and

Majdel Anjar. In light of the exacer-

bation of the gaps in service, MSFis further widening its programmes,

expanding activities to Central Bekaa

where needs are high.

MSF provides free of charge health

care, including medications for acute

and chronic conditions, vaccinations

and antenatal care to all those in need

irrespective of nationality and registra-

tion status.

MSF programmes in Lebanon are pres-

ently implemented through the work of

112 staff (half of those are medical),

both national and international.

MSFs budget for its humanitarian inter-

vention in Lebanon is 4 millions Euros

to date and is being expanded to meet

the needs of this emergency situation.


3/12

M

ichaelGoldfarb/MSF

We ed bombings

in the Damascuscountryside. Our

house was damaged.

We took nothing

with us except some

clothes.

Father of refugee family


The ongoing crisis in Syria is forcing ever more Syrians to ee their homeland in

search of safety. The United Nations High Commission for Refugees (UNHCR) re-

ported in late January that more than 165,000 refugees had ofcially been regis -

tered in Lebanon alone, and that almost 77,000 more were in the process of being

registered . An estimated 50,000 additional refugees are believed to be in the coun-

try but have not attempted to register formally as refugees. And nearly 500,000 have

sought sanctuary in Turkey, Jordan, Egypt and Iraq.

The humanitarian needs of this growing population are immense and growing. Doc-tors Without Borders/Mdecins Sans Frontires (MSF) has been working to provide

aid inside Syria since March 2011, though those efforts have been limited by secu-

rity concerns and access issues. At the same time, however, MSF has expanded its

work with Syrian refugees in Lebanon, Jordan, and Iraq.

This report specically focuses on MSFs work with Syrian refugees and other dis-

placed populations in Lebanon, where MSF teams are providing urgent assistance

and free-of-charge medical care among people now sheltering in Tripoli and in vari-

ous locations of the Bekaa Valley.

In June 2012, MSF conducted a survey among Syrian refugees and Lebanese people

whod been living in Syria but were likewise driven out by the war. The results high-

lighted a number of worrisome conditions. Assistance had been quickly deployed in

the early days of the crisis, and numerous organizations were still supporting the aid

response, but clear gaps were already evident, particularly when it came to access

to medical care. Treatment for chronic diseases such as asthma, diabetes, hyperten-

sion and cardiovascular disease was already a major concern, in large part because

the cost of the necessary drugs was out of reach for many. There were also signi -

cant gaps in hospital-level care, with four out of ten interviewees saying they could

not access a hospital due to cost, insecurity or other reasons.

Citing the survey results, MSF called for the response to be maintained and re-

inforced, and in December 2012, MSF launched another survey of the displaced

populations from Syria now in Lebanon in order to gauge living conditions and check

whether any progress had been made since results of the rst survey were released.

UNHCR. Syria Regional Refugee Response, Information Sharing Portal. Consulted: January 26th.

Available online at: http://data.unhcr.org/syrianrefugees/country.php?id=122

Executive summary


4/12


The results of this most recent survey are detailed below. They show that the gaps in

service that existed last spring have not been sufciently addressed but have in fact

widened as more people have streamed across the border. Living conditions among

the majority of refugees and Lebanese returnees remain extremely precarious, partic-

ularly with winter arriving. More than 50% of those interviewed, whether they were of -

cially registered or not, are housed in substandard structures inadequate collective

shelters, farms, garages, unnished buildings and old schools that provide paltry, if

any, protection against the elements. The rest are renting houses, but many of those

people, now separated from their lives and livelihoods, are struggling to pay the rent.

The medical picture has deteriorated as well. More than half of all interviewees

(52%) cannot afford treatment for chronic disease care, and nearly one-third of

them have had to suspend treatment already underway because it was too expen-

sive to continue. For those who are and are not registered alike, the costs attached

to essential primary health care, ante-natal care and institutional deliveries are

prohibitive. Among non-registered returnees and internally displaced Lebanese, 63%

received no assistance whatsoever from any NGO.

The survey showed that the registration process itself is problematic in ways that

limit the coverage aid organizations can achieve. In fact, 41% of the interviewees

said they were not registered mainly because they lacked information on how and

where to register or the registration points were too far away. Others worried that

they did not have proper legal papers and would be therefore sent back to Syria.

Even among those who had registered, MSFs survey found complaints. Roughly one

in four said they had not received any assistance, while 65% said they had received

only partial assistance that did not cover the families needs.

The specic ndings are laid out below, but the message they convey is quite clear:

Syrian refugees and other displaced people now living in Lebanon have profound

humanitarian needs that are not being met. A similar situation is playing out in other

countries hosting Syrian refugees as well. If these people are going to nd real relief

from the conict plaguing Syria, and if their needs particularly their medical needs

are going to be met, there must be a more expansive, concerted, and effective

humanitarian response.

In light of these widening gaps, MSF calls for national and international humanitar-

ian aid actors to shift policies towards a fully edged emergency response to meet

the needs of the raising refugee population. More specically:

Considering 63% of the unregistered refugees do not receive any assistance, MSF

calls for a scaling up of the humanitarian response to ensure immediate delivery

of food and non-food assistance to all refugees upon their arrival in the country

without conditioning the aid to the completion of their registration process.

MSF calls on authorities to accelerate the establishment of reception centres and

the immediate availability of collective shelters adapted to winter conditions to

cope with the increasing inuxes of new refugees.

With 50% of the refugee population not receiving the required medical treatment

because it is not affordable, MSF urges national and international actors to guar-

antee accessible health care, specically through the provision of free of charge

services to the most vulnerable groups. Money cannot be opposed as an obstacle

to health for a population eeing violence in a war zone.

MSF urges authorities and the UNHCR to ensure that all refugees suffering from

acute medical conditions gain full and fast access to hospital care.

As more than 30% of those in need of treatment for non-communicable diseases

(NCDs) are no longer able to ensure the continuity of their treatment, MSF calls

for the systematic integration of affordable NCD treatment in the health care

system.

Despite the ongoing efforts to accelerate the registration process, more than 40%

still remain unregistered today. MSF calls upon Government of Lebanon, interna-

tional donors, local authorities and the UNHCR to ensure incoming refugees are

registered within days of their arrival, by signicantly expanding the number of

registration points and mobilizing extra dedicated human resources.

Recommendations


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Figure 1:

Percentages of unregistered refugees,

by sampled location, who say they are

receiving enough, not enough, or no aid

(in the form of non-food items, food and

health services). Lebanon December

2012, MSF survey.

27% 29%

65%

19%23%

34%

63%

50%

43%29%

56%

10%

21%

33%38%

48%

9%

2%

0%

20%

40%

60%

80%

100%

Aarsel West Bekaa Hermel Baalbeck Tripoli Saida

Enough

AssistanceNot enoughAssistanceNo Assistance

Bekaa valley


This document provides essential information on the socio-demographic character-

istics of those refugees and displaced in Lebanon, their current living conditions and

their overall health. It also highlights different factors that are limiting access to the

services and aid they require. It is based on the analysis of 2,124 weighted rand-

omized households from four locations in Bekaa Valley (which together comprise

68.2% of the nal sample), Tripoli (24.3%) and Saida (7.2%). Specic vulnerabilities

are highlighted, risk scenarios are presented, and targeted calls for action are made

based on worrisome trends witnessed on the ground by MSFs teams.

The ndings of MSFs December 2012 survey can be broken down into three main

categories: registration issues, issues pertaining to access to medical care, and

issues pertaining to access to housing. In many ways, the three are connected, form-

ing an overlapping set of challenges that are negatively affecting the general health

status of the refugee and displaced populations in Lebanon.

In this section, we will look at and analyze the data gathered. MSFs specic recom-

mendations for addressing each aspect detailed herein are presented in later sec-

tions of this report.

Syrian nationals eeing the war in their homeland make up far and away the largest

proportion of people surveyed (93.7%). However, a rising but underappreciated trend

has emerged in the recent months: new populations are vulnerable as well. This

includes Lebanese returnees from Syria as well as Lebanese displaced within their

country, scattered around the Bekaa valley, mostly in Hermel. This also includes

Palestinian refugees eeing Syria and seeking refuge in the pre-existing Palestinian

camps in Lebanon, notably the Saida and Baalbek camps. Together, these popula-

tion groups made up 6.3% of the sample surveyed by MSF in December 2012.

Overall, most of those displaced from Syria and interviewed by MSF in Lebanon

come from the urban area of Homs and its surrounding villages (37.7%). The next

largest groupings come from Damascus, Daraa and Idlib (36.5%), Aleppo (14.6%)

and Hama (7.4%). This represents a signicant change from MSFs previous survey

in June 2012, which found that 90% of those displaced came from Homs gover-

norate, and it correlates with the internal geographic spread of the Syrian conict.Nearly seven out of every ten people interviewed referred to the current insecurity

and violence in Syria as their main reason for being displaced. Almost one-third

reported having lost a family member during the last 12 months and 90% of those

said that the loss was due to the conict.

MSFs December 2012 survey found that an estimated 41% of the total sample of

people interviewed were not ofcially registered as refugees or displaced. In theory,

registering makes it easier to receive assistance, although as noted below, thats not

always the case (and, in fact, it should not be the case that aid would be linked to

registration). Nonetheless, its clear that in this instance, people who have not reg-

istered face constraints with regard to accessing aid, compared to those who have

registered, and that these constraints have consequences when it comes to living

conditions and general health status.

Methodology

Findings

Origin of refugees

Registration issues


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Figure 3. Distribution (%) of refugees

and displaced populations with access

to various health services by registra-

tion status in Bekaa valley. Lebanon

December 2012, MSF survey.

Figure 2. Distribution (%) of un-

registered refugees and displaced

populations by sampled location and

time since their initial displacement.

Lebanon December 2012, MSF survey.

38%

28%

18%

29%

68%

22% 21%

30%

83%

50%

33%

63%

0%

20%

40%

60%

80%

Bekaa valley Tripoli Saida

< 2 months

3months - 1 year

> 1 - 1.8 years

Total

24%

72%

56%

47% 47%

11%

48%

20%

10%

27%

0%

20%

40%

60%

80%

Free of charge

medication

Free of charge

PHC

Free of charge

Hospital care

Access ANC Chi ldren

vaccinated

Registered

Not Registered


To start, its important to note the reasons why high percentages of refugees are not

registering in Lebanon. Administrative hurdles are part of the problem. Some Syrian

nationals are simply unaware of the scarce, understaffed, and geographically faraway from centralized registration points. Some are also fearful of potential conse-

quences they worry might result from being registered that it might somehow lead

to them getting sent back to Syria. It also takes time and fare for passage to reach

registration ofces. Some families dont have much with them in the way of docu-

mentation, either, due to the conditions under which they left.

Data from MSFs latest survey quanties the percentage of those not-registered by

location, and even though refugees and displaced population groups seem to access

registration over time, 18%, 21% and 33% of people interviewed in Bekaa Valley,

Tripoli and Saida respectively, were rst displaced more than one year ago remain

unregistered. (See Figure 2 above).

Some clear differences emerged regarding how much assistance is reaching those

who are registered and those who are not. In Bekaa valley, for example, MSFs sur-

vey found signicant disparities in how often medical care was accessed by regis-

tered and non-registered population groups (See Figure 3 above).

Pregnant women whove been unable to register have their own particular concerns,

especially as it pertains to health care. Primary among them are the fees they must

pay to deliver their children in medical institutions. MSFs survey showed that even

one of every seven registered refugees nds hospital fees unaffordable.

Women who are not registered might hope for some special dispensation given their

condition, but at present, registration can be fast-tracked only in situations deemed

emergencies and previously assessed and ascertained by UNHCR or UNHCR-

validated iNGOs.

Particular concerns for

pregnant women

Reasons for not registering


7/12

Figure 4. Percentages (%) of refugees

and displaced populations that can ac-

cess affordable treatment, by sampled

location. Lebanon December 2012,

MSF survey.

26.7

62.7

82.2

44.436.2

44.3

13.7

3

10.4

13.7

14.8

71.7

23.6

14.8

45.250.1

40.9

1.6

0%

20%

40%

60%

80%

100%


Affordabletreatment

Sometimes

affordable

Not affordabletreatment

Bekaa valley

We went to the UNHCR

registration center in Zahle

to get registered, but they

told us we couldnt be

registered and had to go to

another center. We went

there and they told us we

couldnt receive any aid

until we are registered.Father of refugee family


In June 2012, MSFs initial survey found that although assistance was quickly de-

ployed in the early days of the crisis, and numerous organizations were still supporting

the aid response, there were already some clear gaps in the services being provided.

While almost half of interviewees, for instance, were found to be in need of medication

and treatment for chronic diseases, 18.7 percent of them were not receiving it. There

were also signicant gaps in hospital-level care; four out of ten interviewees said they

could not access a hospital due to reasons such as cost and insecurity .

MSFs December 2012 survey showed that the situation has deteriorated still further.

It remains too expensive and too difcult for many among these populations in dis-

tress to access essential medications, childrens vaccinations, pre-natal and obstet-

ric care, or medical management of chronic conditions. The build-up of out-of-pocket

health expenditures can reach catastrophic dimensions, and cost-recovery practices

continue to hamper access to most essential health services and care.

Figure 4 below shows that many essential medical treatments have proven impossi-

ble to afford for large numbers of Syrian refugees in Lebanon (the greater disparities

for Hermel and west Bekaa are due to the limited number of health care providers in

those locations).

Issues pertaining to

access to health care

It should be noted that from the outset of the crisis, the Lebanese authorities made

signicant efforts to ensure access to secondary and tertiary levels of care for

refugees and displaced populations. But since June 2012, authorities have said they

lacked the funding to continue these initiatives, a move that has severely hampered

the ability of vulnerable populations to access emergency care. Given the fact that

more refugees continue to arrive in Lebanon, this shortfall will affect greater num-

bers of people in the days to come.

In MSFs 2012 survey, nine of ten interviewees said that the price of prescription

drugs was the main barrier to access. More than half said they could not afford to

buy their medication in Lebanon, a number that seems likely to rise given the steady

stream of new arrivals and the fact that there is little to no employment and thus

very few opportunities to earn an income for them or for the refugees already in

Lebanon.

Across all locations, the vast majority of the population MSF surveyed this was

between 18 and 50 years old, which are usually an individuals prime earning years.

But whereas in Syria, unemployment rates were reported around 15% among males

and 25% among women, rates rose to 50% among male refugees in Lebanon and

close to 60% among female refugees. In such conditions, it will only get harder for

these population groups to cover health and drug costs in the mid- and long-term.

Access to care and drugs

MSF. September 2012. Fleeing the violence in Syria. Syrian refugees in Lebanon. Available upon request.


8/12

Half of our house inIdlib was destroyed in abombing. It is much worse

here. Our children were

healthy in Syria. If they

hear a door close they

think its a bombing.Mother of baby and young girl being

examined at MSF clinic in Majdal Anjar Misery beyond the war zone

The epidemiological prole of populations does not change when they cross borders;

those who needed medications for chronic conditions in Syria still need them in

Lebanon. That includes 38.6% of those interviewed in Bekaa, 37.1% in Tripoli, and

42.3% in Saida. Among those groups, only 18.7%, 28.9% and 8.3% can access themfree-of-charge in Bekaa, Tripoli and Saida, respectively.

For the the rest, essential medical treatments are just not affordable in Lebanon, as

shown above. This is crucial because people with chronic conditions need regular

access to primary health care and regular check-ups and monitoring.

There are sizable gaps in specic forms of medical care as well. Antenatal care for

pregnant women (8.1% of the total sample) is one grave example. Two of three of

these women do not access the services they need. And that number drops to zero

in Hermel, where medical services are even scarcer.

Furthermore, only 32.6% of children are reported to have received vaccinations,

and just 19.2% of the respondents were able to show their vaccination card. More

than 60% do not know if they have a vaccination card or not. The highest vaccination

rates were in Baalbek, with around 50%, while the lowest were reported in Hermel,

7.1%.

Access to adequate food rations is another concern; only 54.2% of the respondents

in Tripoli and 61% in Bekaa and Saida said that they had enough food to meet their

familys needs. It goes without saying that insufcient amounts of food can have

profound health implications.

Lack of certain specic

kinds of care

Access to sufcient amounts of food

M

ichaelGoldfarb/MSF

Interruption of treatment for

chronic conditions


9/12

The situation isextremely bad. We have nosewage system and had

to dig holes in the ground.

When it rains the water

ows into the tents so thekids get sick. Its also very

cold and most families

dont have heaters, so we

have to burn all sorts of

materials. The kids are

sick. Our most important

concern here right now

is medical care. We need

doctors.

Refugee from Deir Zenoun camp


In the survey MSF conducted in June 2012, some 50% of individuals interviewed

said they were being hosted by Lebanese families. In the latest survey, this percent-

age is close to zero, which indicates that there are far fewer living spaces available in

the communities in which people are settling. Many of these refugees cannot affordto pay rent, either, and the community shelters that do exist are not always winter-

ized. As a consequence, higher percentages of refugees and displaced people are

being forced to endure inadequate living conditions.

Some of these inadequate living conditions were detailed in MSFs June 2012

report. The shelters and other living areas set aside for refugees, the report stated,

had some clear and evident shortcomings that would only become more pronounced

once winter arrived. Those shortcomings were not sufciently addressed, however,

and MSFs more recent survey found that the earlier concerns about winter and its

likely impact on the health of refugees and refugee families have indeed come to

pass.

More than 60% of the refugee and displaced population said they had to pay for

housing or shelter; only 37.6% said they were able to afford the rent they were asked

to pay.

The living conditions varied widely between sampled sites. Nearly 53% of the

refugees and displaced population in Tripoli and surrounding areas were living in

shelters, while almost 90% of those in Saida reported sharing rooms or houses and

paying rent.

Interviewees rated the overall conditions differently a well. In Tripoli, 45.5% rated

them as bad or very bad; 32.2% did so in Saida; 24.7% did so in Bekaa. The survey

found that only 13.6% of the shelters or houses in Tripoli, 16.4% in Saida, and 24.7%

in Bekaa had been rehabilitated or adapted to the point where they could protect

against the winter conditions.

M

ichaelGoldfarb/MSF

Issues pertaining

to adequate and

affordable housing

MSF. September 2012. Fleeing the violence in Syria. Syrian refugees in Lebanon. Available upon request.


10/12

Figure 5. Percentages of refugees and

displaced populations reporting their

living conditions ready or not ready for

winter, by sampled location. Lebanon

December 2012, MSF survey.

60.6

76.6

54.8

7872.9

83.6

39.4

23.4

45.2

2227.1

16.4

0%

20%

40%

60%

80%

100%


Ready forwinter

Not ready forwinter

Bekaa valley

I have been here sixmonths and UNHCR hasnot called us back. Iwent three times to try

to register but I have not

been able to. My children

and my wife have skin

conditions and Im relying

on the charity of villagers.

Anywhere in Syria would

be better than here.Father of four, living in single room withsix other people. Fled Homs, where

house was destroyed.


Recommendations

Notably, 12% of respondents in Bekaa reported living in tents, schools, or mosques

places that were not adapted or suitable for winter nights. Overall, in fact, only one

quarter of those surveyed felt they were ready for the winter, as shown in Figure 5

above.

The shelters and houses that are available are often shared by numerous families,

adding yet more strain to the conditions. In some instances, more than 12 people

share a single common room. They appeared to have access to latrines and sanita-

tion services, but access to drinking water remains problematic, particularly in

Tripoli, where fewer than one in two respondents reported having the nancial capac-

ity to afford it.

Generally speaking, living conditions in Tripoli impose particular challenges on refu-

gees, displaced populations, and vulnerable host groups, yet the area has received

little attention from national and international aid agencies. Just 59.3% of those

interviewed in Tripoli reported having received any type of assistance from non-

governmental organizations (NGOs).

The needs facing refugee and displaced populations are signicant and worsening,

as detailed above. But they can be addressed. They can be improved. In order to do

so, and to provide real and sufcient relief to people already reeling from the impact

of the war in Syria, MSF calls for national and international humanitarian aid actors

to bolster their responses on behalf of the affected populations. More specically:

Considering 63% of the unregistered refugees do not receive any assistance, MSF

calls for a scaling up of the humanitarian response to ensure immediate delivery

of food and non-food assistance to all refugees upon their arrival in the country

without conditioning the aid to the completion of their registration process.

MSF calls on authorities to accelerate the establishment of reception centres and

the immediate availability of collective shelters adapted to winter conditions to

cope with the increasing inuxes of new refugees.

With 50% of the refugee population not receiving the required medical treatment

because it is not affordable, MSF urges national and international actors to guar-

antee accessible health care, specically through the provision of free of charge

services to the most vulnerable groups. Money cannot be opposed as an obstacle

to health for a population eeing violence in a war zone.

MSF urges authorities and the UNHCR to ensure that all refugees suffering from

acute medical conditions gain full and fast access to hospital care.

As more than 30% of those in need of NCD treatment are no longer able to en-

sure the continuity of their treatment, MSF calls for the systematic integration of

affordable NCD treatment in the health care system.

Despite the ongoing efforts to accelerate the registration process, more than 40%

still remain unregistered today. MSF calls upon Government of Lebanon, interna-

tional donors, local authorities and the UNHCR to ensure incoming refugees areregistered within days of their arrival, by signicantly expanding the number of

registration points and mobilizing extra dedicated human resources.


11/12

MSF activities

in Lebanon

MSF has been providing primary health care and mental health services

since November 2011 in northern Lebanon and the Bekaa region to all those

in need regardless of nationality. This includes Syrian refugees, Lebanese

returnees, internally displaced Lebanese, and Palestinian refugees displacedfrom Syrian and Lebanese hosting communities.

In 2012, MSF carried out 16,923 consultations in Bekaa valley. A total of

525 patients were registered in the chronic diseases program in 2012 as

well. Between March and December of last year, another 650 individual

cases were admitted for psychological consultations in the mental health

program.

MSF teams carried out 5,134 consultations in Tripoli in 2012; roughly 73% of

them were considered acute cases. A total of 606 patients were enrolled in

the chronic disease program, and some 988 patients were admitted into the

mental health program.

In both areas of intervention, teams saw a high proportion of acute condi-

tions such as urinary tract infections and lower respiratory tract infections,

conditions that are associated with poor living conditions.

Diabetes and hypertension are the prevailing chronic conditions. MSF pro-

vides patients with chronic conditions free-of-charge care and follow-up con-

sultations. Mental health services are also available and MSF teams provide

preventive care and targeted interventions such as childrens vaccinations

and ante-natal care to pregnant women.

Since November 2012, MSF distributed 25,580 basic relief items to Syrian

refugees scattered throughout the Bekaa Valley. In mid-January 2013, MSF

began distributing fuel vouchers to refugees, with 300 families now able to

have heat for two months. As of today, MSF has doubled its staff from 50 to112 and its operational response is scaling up.


Most refugees and displaced people are already vulnerable. Those who are eeing

Syria now and those who have already ed are also dealing with the knowledge that

their homeland is gripped by a brutal war with no end in sight. Yet given current con-

ditions in Lebanon, these populations are being forced to pay an extra price in order

to access health care and nd sufcient shelter.

The Lebanese people and authorities have made an enormous effort to assist

refugees, keeping the border open and providing the services and assistance they

are able to provide. The limits have made themselves evident, however, as have thecosts. It is time for donors to truly commit themselves to doing what is necessary

to address the growing needs of this population, and for national and international

aid actors to evaluate the methods and the amount of the aid they are providing,

because as we can see on the ground, and as these refugees and displaced people

know better than anyone else, the present response still falls far short of meeting

the needs of those most at risk.

Conclusion


12/12

M

ichaelGoldfarb/MSF

Mdecins Sans Frontires

78, rue de Lausanne 1211 Geneva 21 - Switzerland

www.msf.ch

Methodology and any informations upon request: to [email protected]

Published by Mdecins Sans Frontires February 2012

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